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September 1, 2010

Surgery To Repair Torn Shoulder Muscles In The Elderly Can Reduce Pain And Improve Function

by Sam Savage

Repairing torn shoulder muscles in elderly patients is often discouraged because of fears of complications. But a new study conducted at Rush University Medical Center has shown that minimally invasive, or arthroscopic, surgery can significantly improve pain and function.

The study has just been published online in Arthroscopy: The Journal of Arthroscopic and Related Surgery and will appear in the October issue.

"In people over the age of 70, pain is the main issue, and pain relief is a fairly reliable outcome after surgery," said orthopedic surgeon Dr. Nikhil Verma, who led the study. "Patients do not require that their shoulder function be fully restored. They just want the pain to be gone." Verma is assistant professor of orthopedic surgery at Rush.

With that requirement, Verma said, "age is not a contraindication" for the surgery.

Tears in the rotator cuff, the complex of four muscles that stabilize the back of the shoulder joint, occur in about 20 percent of the population over the age of 65 and typically result from chronic degenerative changes. The tears in the musculature cause considerable pain and loss of range of motion.

Surgeons often recommend against surgery for seniors because circulation and bone quality are poorer. Many elderly patients also often have other diseases that can compromise the healing process. But the arthroscopic surgery in the cases studied proved remarkably successful.

A total of 39 patients over the age of 70 underwent surgery to repair full-thickness tears in the rotator cuff after more conservative treatment, such as pain medication and debridement to remove fragments of tissue, had failed. The patients were followed for two years after surgery and their shoulder function was compared with that of similar individuals of the same age who had healthy, normal shoulders.

Range of motion improved significantly. Patients were able to raise their arm in front and rotate it to the side "“ something that for many was difficult or impossible before the surgery. Muscle strength also improved. Pain was reduced significantly in 96 percent of the patients, many of whom had undergone the surgery because their pain was so bad they were unable to sleep. Almost all the patients reported improved function in their shoulder, and 94 percent said they were satisfied and would undergo the surgery again if they had to make the decision over.

When these post-operative results were viewed in light of the normal aging process, the majority of individuals had a shoulder that functioned nearly as well as a healthy shoulder for that age group and gender.

According to the study authors, the success of the arthroscopic rotator cuff repair surgery"”both objectively and subjectively"”in elderly patients was due to newer surgical techniques, as well as the individuals' commitment to post-operative rehabilitation and realistic expectations. Patients who were deemed to have irreparable rotator cuff tears were not offered arthroscopic rotator cuff repair surgery.